Fillable Offset Deposit Account application form (Australian National University)

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Offset Deposit Account application form (Australian National University)

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Credit provider and product issuer is AMP Bank Limited ABN 15 081 596 009, AFSL and Australian credit licence 234517.
Offset Deposit Account application form
This application is for existing home loan customers only. If you are an existing AMP Bank customer and have not provided proof
of your identity to us since 12/12/2007, you may need to be re-identified. Please complete an Identification Verification form and
submit with this application. If you are unsure, please phone 13 30 30 to confirm. You will not be able to operate your account if
the required identification documents are not submitted with the application form.
Please print in CAPITAL LETTERS and place a cross
✗
in any applicable boxes.
1.  Select your account
1.1 Select your customer type
Personal Sole trader Company Trust
1.2 Applicant details
Applicant 1
Surname
First name Middle name(s)
Date of birth
D D M M Y Y Y Y
Current residential address (must not be PO Box)
Suburb State Postcode
Country of residence If Other, please specify
Australia Other
Applicant 2
Surname
First name Middle name(s)
Date of birth
D D M M Y Y Y Y
Current residential address (must not be PO Box)
Suburb State Postcode
Country of residence If Other, please specify
Australia Other
1.3 Source of funds
We will not be able to process your application if this section is not completed.
Applicant 1
Select the source of funds to be used for the offset account(s).
Select the one response most relevant.
Income from employment (regular and/or bonus)
Investment income (eg rent, dividends, pension)
Business income
One-off payment (eg matured investment, court
settlement, redundancy, inheritance)
Sale of assets (eg shares, property)
Windfall (eg gift, lottery winnings, gambling)
Borrowed Funds
Government benefits (eg childcare rebate, family
tax benefit)
Applicant 2
Select the source of funds to be used for the offset account(s).
Select the one response most relevant.
Income from employment (regular and/or bonus)
Investment income (eg rent, dividends, pension)
Business income
One-off payment (eg matured investment, court
settlement, redundancy, inheritance)
Sale of assets (eg shares, property)
Windfall (eg gift, lottery winnings, gambling)
Borrowed Funds
Government benefits (eg childcare rebate, family
tax benefit)
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1.  Select your account (continued)
1.4 Nature and purpose of business relationship
We will not be able to process your application if this section is not completed.
Applicant 1
Select your reason for opening the offset account(s). Select the
one response most relevant.
Everyday banking eg regular deposits and withdrawals for
everyday expenses
Business income eg regular deposits and withdrawals for
expenses (mostly for non-individuals)
Savings eg regular deposits with few withdrawals, earning
interest to grow your balance
Building wealth eg a large initial deposit, using investment
returns to grow your wealth over time
Applicant 2
Select your reason for opening the offset account(s). Select the
one response most relevant.
Everyday banking eg regular deposits and withdrawals for
everyday expenses
Business income eg regular deposits and withdrawals for
expenses (mostly for non-individuals)
Savings eg regular deposits with few withdrawals, earning
interest to grow your balance
Building wealth eg a large initial deposit, using investment
returns to grow your wealth over time
1.5 Additional tax details
You are required to provide the taxation status of all applicants, even if they are also tax payers in Australia. The ATO website
provides residency test calculators to help determine tax residency, and information on CRS and FATCA. Additional information
about CRS and FATCA can be found on the OECD and IRS websites (oecd.org and irs.gov).
Personal Customers and Sole Traders
Are you a foreign tax resident?
Applicant 1
Yes No Applicant 2 Yes No
If you are a foreign tax resident and a taxpayer in Australia, you should answer ‘Yes’. All foreign tax residents and US citizens and
resident alien individuals (ie green card test and substantial presence test) should answer ‘Yes’.
If you are a foreign tax resident, please provide details below. If you are unable to provide a Tax Identification Number (TIN), you
must select a one reason from the available list. A tax identification number is an identifying number used for tax purposes,
normally issued by the local tax authority in a country – eg in Australia, the ATO issues a Tax File Number (TFN).
Applicant 1 Applicant 2
Country
Country
TIN TIN
A The country of tax residence does not issue TINs A The country of tax residence does not issue TINs
B
The country of tax residence issues a TIN but I cannot
provide it
B
The country of tax residence issues a TIN but I cannot
provide it
C
The country of tax residence does not require TIN to be
disclosed
C
The country of tax residence does not require TIN to be
disclosed
Please copy and attach this page if you are a tax resident in more than one foreign country. You must provide details of each
country, and each TIN (or reason A, B, or C for not having a TIN) on this form.
Companies and Trusts
You must complete this section if you are applying for an Offset Account and the applicant is either an Australian Proprietary
Company or an Unregulated Trust (eg Family, Unit, Estate).
Is the company or trust a foreign tax resident?
Yes N o
Does the company/trust have any controlling persons who are foreign tax residents?
Yes N o
If any entities have been identified as foreign residents, then a completed Foreign Tax Residence Declaration – Entities form should
be submitted with this Offset Deposit Account application form. The form is available at amp.com.au.
3 of 6
1.  Select your account (continued)
1.6 Offset Deposit Account applications
Up to 10 Offset Deposit Accounts can be linked to each loan split. An Offset Deposit Account may be opened in one, some or all of
the applicant(s)’ names.
Loan Split 1 for
$
Access options required:
AMP Visa Debit Card Cheque Book Deposit Book
Account Holders
for Offset 1
Account Holder 1
Account Holder 2
Account Holders
for Offset 2
Account Holder 1
Account Holder 2
Account Holders
for Offset 3
Account Holder 1
Account Holder 2
Loan Split 2 for
$
Access options required:
AMP Visa Debit Card Cheque Book Deposit Book
Account Holders
for Offset 1
Account Holder 1
Account Holder 2
Account Holders
for Offset 2
Account Holder 1
Account Holder 2
Account Holders
for Offset 3
Account Holder 1
Account Holder 2
Please copy this page and attach if you require Offset Deposit Accounts on more than 2 loan splits or more than 3 Offset Deposit
Accounts per loan split.
2.  Nominate an existing bank account
If you would like to register an existing bank account to transfer money from your new AMP Bank account to another AMP Bank or
other financial institution account complete the section below. Your nominated account must not be a credit card.
Adding an external account here will be visible to all account holders on their external account lists. If you wish to separately link
accounts, please fill in the Register or Cancel an External Bank Account form, available at amp.com.au.
Please note: The default Daily Transfer Limit for withdrawals from your AMP Bank account to the account detailed above is $5,000.
The Daily Transfer Limit will include all withdrawals from your AMP Bank deposit account to that account on any single day. You
may nominate (below) a higher or lower Daily Transfer Limit to apply to transfers from your AMP Bank Deposit account to the
account detailed above. The maximum permitted Daily Transfer Limit amount is $250,000.
Daily Transfer Limit
$
Account in the name(s) of
Name of Australian financial institution
Branch State Postcode
BSB Account number
You authorise the following:
1. AMP Bank to verify the details of the account with your financial institution.
2. Your financial institution to release information allowing AMP Bank to verify your account details.
Warning: Please enter your details correctly as AMP Bank will not be liable for any loss or other consequences arising from the
account information being incorrect. Your existing bank account details can be found on a previous bank statement or cheque book.
4 of 6
3.  Internet Banking and BankPhone access
Your Offset Deposit Account will become available with your existing Internet Banking access.
Applicant 1 – Enter your current User ID Applicant 2 – Enter your current User ID
(customer number not your PIN) (customer number not your PIN)
4.  Electronic communication
Select ‘Yes’ below if you agree to receive information by electronic communication. If you are an existing AMP Bank customer, your
selection will apply to all accounts. If you don’t make a selection then your existing preferences will apply.
Things you need to know before you select ‘Yes’ to electronic communication
Paper documents may no longer be given, some communications may be made available in My AMP and we’ll notify you by email,
you’ll have to check regularly for electronic communications, and you can change your electronic communications preference back
to paper communications at any time in My AMP or by calling us on 13 30 30.
In some cases, communications will be sent electronically even if you opt for paper. For details see the Account Access and
Operating Terms and Conditions, available at amp.com.au/bankterms.
Yes, I’d/we’d like to receive information by electronic communication.
5.  Account signing authori ty
Please choose your signing authority:
Any to sign (any one of the signatories can operate the account without the others’ permission).
All to sign (all of the signatories are required to act to operate the account). Access Cards can be issued with deposit only functionality.
Any two to sign (two of the signatories are required to act to operate the account). Complete only for three or more Applicants.
Access Cards can be issued with deposit only functionality.
6.  National Relay Service registration
If you wish to register for National Relay Service please visit amp.com.au/bank/nationalrelayserviceform
7.  Privacy Collection and Disclosure Notice
AMP Bank collects personal information from you (the Individual) in this application. Personal information:
– is required to be collected under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006.
– is required and if not provided AMP Bank may not be able to process this application.
– is collected to identify the Individual, to establish new products and services, to manage existing product(s) and services and
for related purposes including marketing and research.
– is collected about the Individual throughout the customer relationship, for the purposes of managing accounts and verifying
or updating personal information held about the Individual. The disclosures below relate to personal information collected at
any time.
– can be disclosed to related bodies corporate for their marketing and research purposes and, to joint venture partners, business
partners, associates, advisers, market researchers and service providers both here and overseas. From March 2014, a list of
countries where these providers are likely to be located can be accessed via the AMP Privacy Policy.
– can be disclosed with other information AMP Bank holds about the Individual to a financial adviser, broker or originator named
in this application, or to joint venture partners, business partners and third party service providers for the purpose of those
parties providing the information to the financial adviser, broker or originator named in this application.
– is treated in accordance with the AMP Privacy Policy which contains information about how individuals may access their
personal information held by AMP and how they can seek correction of that information or make a complaint about a breach of
the Australian Privacy Principles and how AMP will deal with this complaint.
The AMP Privacy Policy is available at amp.com.au.
To opt out of direct marketing from AMP Bank, to obtain further information about how AMP handles your personal information
or to request access to the personal information AMP holds about you, call 13 30 30 or write to:
AMP Bank, Locked Bag 5059, PARRAMATTA NSW 2124
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8. Declaration by Applicant(s)
The following declaration is made by each Applicant separately:
By signing below I declare, acknowledge and confirm that I:
1. Have authorised AMP Bank to verify my account details as set out above.
2. Have read and understood the Privacy Consent and Disclosure Statement contained in AMP Bank’s Deposit Products Terms
and Conditions.
3. Have read and agree to be bound by the Direct Debit Request Service Agreement (if applicable).
4. Have reviewed and accepted the relevant Account Access and Operating Terms and Conditions, Fees and Charges Guide, and
Product Terms and Conditions or Product Disclosure Statements available at amp.com.au/bankterms and I can call 13 30 30
to have copies sent to me. I understand that I will automatically agree to them the first time I, or a person authorised by me,
operates the account.
5. Understand that AMP Bank may decline this application for any reason in its absolute discretion.
6. Am not commonly known by any other names different to those disclosed in this application form, unless I have disclosed
otherwise to AMP Bank.
7. Have provided true and accurate information in relation to this application. Any document or information to be used for the
purposes of this application (whether or not provided on or with this application):
– is correct and complete
– if it’s about another person, is provided with the authority of that person (if required), and
– may be used for any other products, services or benefits offered or provided to me through AMP Bank or any other company
in the AMP group and subject to their privacy obligations, may be disclosed to and used by the providers of such products,
services or benefits to facilitate compliance with anti-money laundering and counter-terrorist financing legislation.
8. Understand that it may be a criminal offence to knowingly provide false or misleading information or documents in
connection with this application.
9. Understand that I/we must notify AMP as soon as is possible when my/our tax residence, or that of the entity or the entity’s
controlling persons, changes.
10. Consent to AMP Bank providing information held about the account(s) being applied for and the account holder(s) to a
financial adviser, broker or originator named in this application, and/or to joint venture partners, business partners and related
party and third party service providers for the purposes of those parties,
i. providing the information to the financial adviser, broker or originator named in this application, or
ii. providing administration services to the account holder(s).
Such information may comprise customer information (including personal information), account documentation and account
information (including account balance, and current and historical account and transactional information).
Where I have appointed an agent or third party signatory and that person is signing this application on my behalf, the last three
declarations above are also given by and bind my agent or third party in the agent’s or third party’s personal capacity. I will provide
proof of authority (such as a Power of Attorney, accompanied by a Third Party Access form) which form I have obtained from
amp.com.au.
By submitting this application I also acknowledge that AMP Bank may decide to delay or refuse any request or transaction (this
includes preventing withdrawals from the account) if AMP Bank has not been able to verify my or a signatory’s identity, or if AMP
Bank believe in good faith that allowing the transaction may cause an offence to be committed. I understand that AMP Bank does
not accept responsibility for any such delay or refusal.
Signature of Applicant 1 Signature of Applicant 2
✗ ✗
Name of Applicant 1 (print in CAPITAL LETTERS) Name of Applicant 2 (print in CAPITAL LETTERS)
Date Date
D D M M Y Y Y Y D D M M Y Y Y Y
Company or Trust Applicants:
Name and position of signatory (print in CAPITAL LETTERS) Name and position of signatory (print in CAPITAL LETTERS)
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9.  AMP representative/AMP financial advise r only
AMP Bank sales channel agent to confirm:
1. I declare that I have sighted the original identification documents or certified copies of the identification documents detailed
above (as indicated). Copies of the documents sighted are attached and submitted with this application.
2. I declare that:
I have not given any advice to the Applicant(s) on AMP Bank’s Deposit Products.
I have given advice to the Applicant(s) on the relevant AMP Bank Deposit Product(s) and I am qualified to provide this advice.
AMP sales channel agent name (print in CAPITAL LETTERS)
AMP sales channel agent signature
✗
Sales ID number Source code
Business name of AMP sales channel agent
Contact phone number
Where to send this form
Mail (no stamp required) or email this completed form to:
AMP Bank
Reply Paid 79702
PARRAMATTA NSW 2124
deposits@amp.com.au
NS4461 04/21
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Completed 12 September 2021

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